November Election Results: Impacts and Next Steps in CA Health Policy: What’s New, What’s Next?

Obamacare Wins! Implementation Steams Ahead With the Supreme Court decision and the President’s re-election, the Affordable Care Act is assured of implementation. While there’s more to do, “Obamacare” is the biggest Congressional action to: 1)Provide new consumer protections to prevent the worst insurance industry abuses Biggest reform of insurance practices ever: no denials for pre-existing conditions; no rescissions; no lifetime/annual caps on coverage; etcBiggest reform of insurance practices ever: no denials for pre-existing conditions; no rescissions; no lifetime/annual caps on coverage; etc 2) Ensure security for those with coverage, and new and affordable options for those without coverage Biggest expansion of coverage in 45 years; Would bring US from 85% to 95% coverage.Biggest expansion of coverage in 45 years; Would bring US from 85% to 95% coverage. Expansion of Medicaid and a new exchange, with affordability tax credits so premiums are tied to income, not how sick we are.Expansion of Medicaid and a new exchange, with affordability tax credits so premiums are tied to income, not how sick we are. 3) Begin to control health care costs, for our families & our govt. Multiple efforts to ensure quality & reduce costMultiple efforts to ensure quality & reduce cost Biggest deficit reduction measure in a generation.Biggest deficit reduction measure in a generation. Big investments in prevention, with unbooked savingsBig investments in prevention, with unbooked savings

More Election Results No supporter of the Affordable Care Act lost to an opponent of “ObamaCare” No supporter of the Affordable Care Act lost to an opponent of “ObamaCare” –U.S. Senate: Democrats increased margins, including in tough states like Missouri and Montana where candidates defended the ACA. –California House: Democratic gains includes likely defeat of 3 incumbents and ACA opponents: Bilbray; Bono Mack; Lungren. (Last two defeated by doctors with safety-net experience: Dr. Raul Ruiz and Dr. Ami Bera) –California Legislature: Democrats increased margins to 2/3 supermajorities.

Prop 30! Prevents “trigger cuts” to education & public safety, by raising $6 billion/year in revenue to the state budget, through temporary increases in upper-income tax rates, and a slight quarter-cent hike in sales tax (which would still be less than last year). Stabilizes budget after years of tough cuts Health and human services 2 nd biggest budget item after education; 1/3 of the state budget. Health and human services 2 nd biggest budget item after education; 1/3 of the state budget. $15 billion in cuts to health & human services in the last three years, such as: $15 billion in cuts to health & human services in the last three years, such as: –Elimination of Denti-Cal and 9 other Medi-Cal benefits –Elimination/transition of Adults Day Health Centers –Elimination/transition of Healthy Families No restorations triggered—but helps prevent further cuts to health No restorations triggered—but helps prevent further cuts to health Creates a firmer fiscal foundation for reform Creates a firmer fiscal foundation for reform

HEALTH REFORM: Next Steps & The Special Session

California Leading on Health Reform California needs to maximize the benefit—our health system needs all the help we can get California needs to maximize the benefit—our health system needs all the help we can get California leads, and can show the way among states with significant uninsured populations… California leads, and can show the way among states with significant uninsured populations…

Fulfilling the Promise: California 2010 Legislation –Created an Exchange that is transparent, consumer- friendly, easy-to-use, fairly governed, and that negotiates with the insurers to provide the best value to consumers: AB1602 (Perez) & SB900 (Alquist/Steinberg) –Ensured availability of child-only plans, prohibited children with pre-existing conditions to be denied coverage, and limited higher rates: AB2244 (Feuer) –Made rate hikes (& justifications) public: SB1163 (Leno) –Conformed state law to many new federal consumer protections, including rescissions, dependent coverage up to age 26, no cost-sharing for preventative care, etc.

The Exchange in CA California’s first-in-the-nation legislation to establish an Exchange post-reform: Provides for “selective contracting,” so it can negotiate for individuals and small businesses, who otherwise are left all alone at the mercy of the insurers. Can serve as the HR department for CA, getting a better deal, vetting products, providing neutral and credible information, standardizing benefits, and fixing issues that come up. Five board members appointed: HHS Secretary Diana Dooley (Gov. Brown); Kim Belshe and Susan Kennedy (Gov. Schwarzenegger); Paul Fearer (Speaker Perez) ; Dr. Bob Ross (Senate President Steinberg). Five board members appointed: HHS Secretary Diana Dooley (Gov. Brown); Kim Belshe and Susan Kennedy (Gov. Schwarzenegger); Paul Fearer (Speaker Perez) ; Dr. Bob Ross (Senate President Steinberg). Initial work: Hired an Executive Director, Peter Lee, and staff; created business plan; Sought and got $39 million in federal funds through 2012; Start work on eligibility and enrollment systems; IT systems; navigation; stakeholder process; public education and outreach; etc. Initial work: Hired an Executive Director, Peter Lee, and staff; created business plan; Sought and got $39 million in federal funds through 2012; Start work on eligibility and enrollment systems; IT systems; navigation; stakeholder process; public education and outreach; etc.

Fulfilling the Promise: California 2011 Legislation –Reformed key systems to help consumers get coverage and care, to be ready ramping up to 2014:  Eligibility and Enrollment: AB1296(Bonilla) outlines a “no wrong door” philosophy for signing up Californians for coverage.  Consumer Assistance: AB922(Monning) enhances & expands the Office of Patient Advocates as a triage center for questions and complaints about coverage and care. –Instituted new consumer protections and insurance oversight, to align with federal law:  Medical Loss Ratio: SB51(Alquist) would allow state regulators to enforce new federal standards to ensuring premiums dollars go to patient care, not administration and profit.  Maternity Care: AB210(Hernandez)/SB222(Evans) mandates maternity services as a basic benefit by July 2012.

Fulfilling the Promise: California 2012 Legislation –Instituted new consumer protections and insurance oversight, to align with federal law:  ESSENTIAL HEALTH BENEFITS: AB1453 (Monning) / SB951 (Hernandez)—set a minimum standard for health plans (equivalent to a Kaiser small group HMO), so consumers have more confidence that their coverage is comprehensive.  SMALL GROUP MARKET REFORM: AB1083 (Monning) prevents small businesses from seeing spikes in insurance premiums if their workers get sick. Also:  NOTICE OF COVERAGE OPTION DURING LIFE CHANGES: AB792(Bonilla) requires that consumers are informed of their coverage options in the new Exchange when losing coverage-- such as during a job change, divorce, adoption, and other circumstances.

Fulfilling the Promise: (LIHP) Low Income Health Program A win for the county, the uninsured, and the health system: –County gets new federal matching funds, for dollars they already largely already spend on indigent care, helping their health system and their local economy. –Now 550,000 uninsured get coverage prior to 2014; a medical home providing primary and preventative care, not just care at the emergency room. –Since this coverage is grounded in county-based systems of care, these new dollars go to shore up safety-net institutions, including public hospitals, community clinics, and other providers. –This serves as a bridge to health reform, ensuring these patients are getting treated and in systems of care before 2014, and ready to get full Medi-Cal (or exchange-based) coverage on day one, maximizing enrollment and federal funds for California. –This isn’t a long-term obligation: In fact, the more people are enrolled in these programs, and thus quickly shifted to Medi-Cal in 2014 with 100% funding by the federal government, the more county resources can be refocused to better serve the medically indigent who remain uninsured after 2014.

Reform is Real Californians are feeling the benefits already. Californians are feeling the benefits already. –14,667 “uninsurable” Californians are enrolled in the Pre-Existing Condition Insurance Program for those denied coverage due to pre-existing conditions. –552,000 Californians are enrolled in coverage through the Low Income Health Program (LIHP) in 51 counties, which serves as bridge coverage for the low-income uninsured who will qualify for Medi-Cal in –355,927 young adults in California have coverage who might otherwise have become uninsured, since they are covered by their parents’ insurance. –8,978,000 insured Californians gained new consumer protections, including Medical Loss Ratio requirements that require insurance companies to spend more premium dollars on medical health care. 1.9 million California residents received $74 million in rebates from insurance companies who did not meet these minimums. –California consumers saved over $100 million dollars in savings from rate hikes that were retracted, reduced, or withdrawn due to rate review. –319,429 California seniors in Medicare saved $171,983,735 in prescription drug costs, an average of over $500 a patient facing the “drug donut hole.” –Over 12 million Californians no longer have a lifetime limit on their health insurance plan. –Health plans in California must all cover maternity care.

2013 Special Session Agenda: Consumer Protections & Insurer Oversight Watchdog the federal and state government to ensure that new consumer protections are implemented and enforced. Watchdog the federal and state government to ensure that new consumer protections are implemented and enforced. –Focus at the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) –Continued focus on rate review has generated hundreds of million in savings through scaled-back and withdrawn rate hikes. Ensure Californians know about their new rights and options. Ensure Californians know about their new rights and options. Start to transition from the “Wild Wild West” insurance market: phasing in benefits, standards, and options to be ready for (Bill numbers from previous session) Start to transition from the “Wild Wild West” insurance market: phasing in benefits, standards, and options to be ready for (Bill numbers from previous session) –INDIVIDUAL MARKET REFORM: AB1462 (Monning) / SB961 (Hernandez) –COST SHARING LIMITS: AB1800 (Ma) –Maybe: RATE REGULATION: AB52(Feuer) / Scheduled for 2014 ballot measure Fight efforts to weaken, defund, undermine, and repeal these consumer protections and the rest of reform. Fight efforts to weaken, defund, undermine, and repeal these consumer protections and the rest of reform.

2013 Special Session Agenda: Ensuring Californians Get Coverage: The Day One Challenge Eligibility and enrollment (bill numbers from prior session): Eligibility and enrollment (bill numbers from prior session): –2014 MEDI-CAL EXPANSION: AB43 (Monning) / SB 677 (Hernandez)  Medicaid Benchmark Benefits  Eligibility and Enrollment Rules  Continuation of current State Programs: FamilyPACT, PRUCOL, etc. –PRE-ENROLLMENT: AB715 (Atkins) Work to implement and improve: Work to implement and improve: –Streamline enrollment in Medicaid, Healthy Families, the Exchange and elsewhere; no wrong doors; –Get ready so millions of Californians get covered on Day One—January 1, 2014—and California maximizes federal money. –Create integrated system of “navigation”—right now, patchwork of county workers, brokers/agents, community groups, etc. –Work at the Legislature and at the Exchange, DHCS, etc. –Enrollment starts October 2013—ten short months away.

Fulfilling the Promise: What a Community Can Do Educate the Community about Their New Rights, Options, Benefits, and Consumer Protections Educate the Community about Their New Rights, Options, Benefits, and Consumer Protections Engage Communities and Consumers Every Step of the Way Engage Communities and Consumers Every Step of the Way Maximize Federal Dollars for County and Community Maximize Federal Dollars for County and Community –Grant opportunities –Matching Dollars for Medi-Cal, Healthy Families, LIHP, etc. Aggressively Implement the Low-Income Health Program Aggressively Implement the Low-Income Health Program Be Ready So Community Residents Get Coverage on Day One Be Ready So Community Residents Get Coverage on Day One –Set a Goal and Date; Work backwards to Meet That Goal –Systems in place for easy enrollment through no wrong door Transform the Safety-Net to Survive and Thrive Transform the Safety-Net to Survive and Thrive –A Business Plan for Safety-net institutions –An Assessment and Augmentation of County-wide Capacity Use the New Tools in the Law Use the New Tools in the Law –To focus on delivery system reform for cost, quality, safety & equity –To build health in all policies, with place-based policy interventions

So Much More To Do: What Can You Do? 1. Thank your member of Congress/Tell them not to repeal it: Call, write, or visit your Congressional Representative and thank them for their yes vote – or attend a public event to thank them! 2. Share your story personal stories help others learn how they can benefit from reform – and they are a compelling advocacy tool! 3. Support state efforts to implement and improve reform let your local representatives know that you support robust implementation and improvement of reform. 4. Write a letter to the editor in support of reform and all its benefits. 5. Join our mailing list to keep up to date on legislative development and get important action alerts! –Sign up at for updates –Check out our daily blog, at blog.health-access.org –Check out our Facebook and Twitter feeds

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